Holding Off on Treatment to "Save Money"

A television commercial ended with this rather succinct comment by a smiling service station owner, "You can pay me now, or you can pay me later." The thrust of the message was that if automobile owners didn't spend the money up front on maintenance and servicing, it would cost them a good deal later in the form of major repair work. It is a lot like that in the equine world.

Often, holding off on treatment to save money in the form of vet bills results in longer, more expensive treatment, with the horse's performance or reproductive career being placed in jeopardy. When dealing with an automobile, one can replace tires or even an entire engine. It isn't that easy with horses. When the "tires" or "engine" suffer damage, it can be permanent, with no replacement parts available.

The problems that can cause permanent damage if not dealt with properly and in the early stages are many and varied. They include such things as colic, wire cuts, puncture wounds, ulcers, dystocia, dentistry, and laminitis.

The last item listed -- laminitis -- is one where early diagnosis and treatment is critical. For a look at laminitis and the other afflictions listed, we turn to five individuals who deal with these problems on a daily basis. Included are Nathanial A. White II, DVM, MS, Dipl. ACVS, and four Riverton, Wy., practitioners -- the veterinary team of Glen Gamble, DVM, and Gunda Gamble, DVM, Amy Stockton, DVM, and Jim Briddle, DVM. All have seen their share of equine medical problems where early treatment would have staved off expensive treatment and serious consequences.

Laminitis

First, a look at laminitis, or founder, and the need for immediate treatment. Laminitis can be caused by many factors, says Gunda Gamble, including grain overload, retained placenta, a protein-rich alfalfa diet, colic, and acute or chronic trauma to the foot.

"The very nature of laminitis," she says, "implies that in most cases, the horse owner has waited too long before calling the veterinarian. It is a condition that, once observed, should be treated immediately. Failure to do so puts the horse at risk of permanent damage to the foot, rendering it irreversibly lame."

The symptoms, Gamble says, include a stance with the front feet pointing forward as the horse attempts to relieve pressure and pain by placing more weight on its hindquarters, painful response to hoof testers and, in serious cases, a horse that is unable to walk and lies down in an effort to relieve pressure.

Gunda Gamble gives this brief explanation of what occurs when laminitis strikes:

"Laminitis is inflammation at the site of attachment between the matrix and the hoof wall. The inflammation occurs with poor blood flow to the foot as a result of increased systemic blood pressure. The poor blood flow leads to ischemia or cell death -- breakdown of lamellar interdigitation between the matrix and the hoof wall (white line).

"This process releases toxins and anabolic byproducts which, in turn, depress blood flow to the foot, allowing further ischemia. In time, infection by systemic bacteria can set in. Infection sets the stage for detachment of the hoof wall and rotation of the coffin bone distally as a result of the persistent pull of the superficial and deep digital flexor tendons.

"Phalanx three (coffin bone) may eventually penetrate the sole of the foot, exposing itself to infection and mechanical trauma. The disaster in this case is complete and virtually irreversible."

Gunda Gamble provides the following scenarios that can be involved in an onset of laminitis, along with possible treatment on the part of a veterinarian who is immediately called to the scene.

Grain Overload or Protein-Rich Alfalfa Diet
This can cause excessive fermentation of carbohydrates, with the end result being vasoconstriction in the foot. Treatment would take the form of oiling the horse via a nasogastric tube and maintaining it on low doses of banamine.

Retained Placenta
If the placenta is retained three to four hours after a mare gives birth, a veterinarian should be called to remove it, flush the uterus, and initiate treatment that would include the administration of antibiotics, cortisone, and banamine.

Colic
"Any colic," says Gunda Gamble, "that has progressed and has allowed gut absorption of toxins should prompt the owner to call a veterinarian for the sake of treating the colic and preventing founder."

Foot Trauma
This can take the form of acute trauma -- such as a stone bruise or being ridden or worked on a hard surface -- or chronic trauma -- such as that which occurs in racing and other competitive events. In either case, the trauma can result in compromised blood flow to the distal limb. Improper trimming, such as a sudden change in angle or quicking, also can bring on trauma that can result in laminitis, she says. Treatment includes administering analgesics, padding the foot, paring out a sole abscess, and allowing proper drainage. Proper trimming and shoeing are musts.

Laminitis, Gunda Gamble concludes, can be mild or severe, but whatever the situation, immediate treatment by a veterinarian is critical.

Colic

The equine "belly ache" can take many forms. In some cases if left untreated, it can result in a horse's death. The question the owner must ponder is whether to wait and see if the distress is merely the result of an upset digestive tract, or whether it is more serious, such as a twist, impaction, or a severe gas colic.

"Every colic is a potential red alert," says Briddle.

The horse owner, he says, can better determine the seriousness of the colic by being familiar with the horse's vital signs. If the owner knows, for example, what a normal pulse rate is for the horse, it is very easy to determine whether the pulse rate is elevated.

White, the Theodora Ayer Randolph Professor of Surgery at the Marion duPont Scott Equine Medical Center at Virginia Tech in Leesburg, Va., provides an example of how an attempt to save money in the form of an emergency fee resulted in a much greater loss.

"We had a case where the owners called a veterinarian to examine a horse with colic. The veterinarian wasn't sure, but felt surgery was likely needed and that the horse should be referred for possible surgery. The owners wanted to wait to see if the horse responded to medical treatment. The next day, the horse still had colic, and now had evidence of shock. The horse was referred and taken to surgery because of bowel distention. The colon had been twisted and the cecum had ruptured, making treatment impossible. Not only did the owner still pay an emergency fee, but also the cost of intensive care and the loss of the horse."

White's implication is obvious. Had the horse been taken to surgery the night before, it might have been saved.

Even the less severe forms of colic, such as impaction and gas, carry life-threatening dangers, says Briddle. Most impactions, he says, are in the large colon. As time goes on, the pressure of the impaction squeezes all natural lubricant from the tissue and it becomes necrotic. If the tissue becomes dry, there is danger that it will split and peritonitis will be the result.

If the colic is caused by gas, Briddle says, there will be an obvious bulging of the horse's right flank area as the condition worsens. This indicates that the cecum is expanding with gas that isn't being dispelled. The ultimate result, if untreated, can be a cecum that bursts like an overfilled balloon.

Owner education is important, Briddle maintains. The owner should be able to differentiate between normal gut sounds and those that occur when gas, impaction, or a twist occurs.

Dentistry

"We could save our clients a ton of money if they would have their horses' teeth tended to on a regular basis," says Stockton. Proper dental care, she says, insures that the horse is able to masticate its food properly. It also is a preventative for conditions later in life, such as malocclusion and wave mouth.

In the case of young horses, the teeth should be examined thoroughly every six months by a veterinarian, she says, and for adults it should be an annual examination (see Does Your Horse Need A Dentist, The Horse, March 2000 or http://www.thehorse.com/ViewArticle.aspx?ID=151).

Tendon Injury

Injuries to a horse's tendons have the potential to end the animal's performance career and are something that should not be ignored, even though the injury might seem minor with only a little swelling involved (see Tendon Injuries in The Horse, September 2000, or http://www.thehorse.com/ViewArticle.aspx?ID=3087).

"Slight swelling of a tendon can be just the tip of the iceberg," says White.

If tendon fiber damage has occurred, he points out, continued exercise will compromise the healing.

"In this case," White says, "getting a full evaluation can reduce the time of healing (by taking the horse out of work and administering appropriate treatment), and increase the chance for a full recovery. Delaying the evaluation and continuing work can increase the damage, prolong the recovery, and potentially prevent the horse from returning to the original level of performance."

Ulcers

A common problem in foals and horses under stress are ulcers, says Stockton. Classic symptoms include not eating, grinding of the teeth, and exhibition of pain similar to colic (see Ulcers in The Horse, November 2000, or http://www.thehorse.com/ViewArticle.aspx?ID=394).

The danger in not treating ulcers early, she says, is that they might worsen and ultimately perforate, with peritonitis being the result.

Wire Cuts

Perhaps one of the most neglected equine health problems is the wire cut. The owner looks at the cut, administers an antibiotic, sprays on some wound powder and turns the horse back out to pasture. Such a procedure, says Glen Gamble, is an invitation to problems of a more serious nature.

The wound should be examined by a veterinarian, he says, to determine whether there has been bone or tendon damage.

He cited one case where a cut lacerated the periosteum covering the bone. This, he says, allowed infection of the bone to occur and the result was a long and expensive treatment and healing process because the wound wasn't properly tended in the early stages.

White provided another scenario. He used as an example a horse which sustained a wound directly over the tibiotarsal (hock) joint. The wound might appear to be clean with little swelling, no bleeding, and minimal lameness, he says. As a result, the owner sees no need for veterinary care, and the horse is treated with antibiotics for two days and turned out to pasture.

"A day later," White continues, "the horse has a swollen hock joint and is very lame. The veterinarian called to examine the horse diagnoses a septic joint. The joint is flushed and antibiotics started. The infection slowly gets better over a prolonged and costly treatment period.

"Unfortunately, because of the delay in identifying the problem, the joint develops chronic arthritis, and the horse cannot be used for its original purpose. Although it costs money to have a veterinarian examine and treat apparently simple wounds, the money might be very well spent because early identification of the joint involvement likely would have reduced treatment costs and allowed full function of the horse."

Stockton is in agreement when a joint is involved. When a horse has been kicked in the knee, she says, the owner often waits to see if the swelling goes down in a few days. If it doesn't, a veterinarian is called.

"I want to see that joint immediately," she says emphatically.

A concern with home treatment of wire cuts, says Gamble, is administration by the owner of improper medication. Most abused, he says, is the administration of antibiotics. The owner might give the horse one light dose, when heavier doses over a period of time are appropriate in that situation.

Then, there is the matter of applying an inappropriate powder or ointment, such as scarlet oil, to the wound. Instead of helping in the healing process, the product stimulates the formation of proud flesh.

Some wounds, he says, should be sutured immediately. Others should be pressure wrapped.

There also is the danger of clostridial infections, especially when puncture wounds are involved.

Dystocia

From the time a pregnant mare goes into labor until she gives birth is often no more than 30 minutes. What this means is that if she has a problem, there is a very narrow window of opportunity to intervene and lend assistance.

"Horses normally have little problem when foaling," says Briddle, "but when they do, it is a wreck."

If there is a problem, frequently it will be with improper presentation, such as the foal being breech or having a leg or the head misaligned. The challenge, when this occurs, is to push the foal back through the birth canal until it can be aligned properly. Making this extremely difficult are the powerful muscular contractions of which a mare is capable.

A procedure Briddle learned some years ago that can help in this endeavor involves inserting a naso-gastric tube into the mare's trachea. This, he says, prevents her from closing the epiglottis, and if the epiglottis is open, she is unable to exert the same muscular thrust.

Sometimes, says Gamble, dystocia problems are worsened by ignorance on the part of the owner. He described one incident where the owner was familiar with cattle giving birth, but this would be the first foal she had seen born. When she called the clinic for help, she reported that the nose had been visible for some time, but nothing more had developed. Because this was not unusual with cattle, she had not bothered calling sooner.

"When I got there," Gamble says, "both of the foal's feet had perforated the rectum." The result was a dead foal and a mare that could not be saved.

Close observation of mares about to go into labor is essential. Gamble recounted an incident at a large horse operation where a mare fell through the proverbial crack in the observation department. When the attendant discovered that the mare was having problems, Gamble was called, but it was too late. The foal died in the birth canal.

"It was obvious that it had been dead only a short time," he says. "If they had realized a half hour earlier that there was a problem, we could have assisted the mare immediately, and there is a very good chance the foal would have survived."

Another problem for the mare owner in deciding whether there is a dystocia, says Briddle, involves the fact that a mare can "shut down" the birthing process if startled or stressed by outside forces, such as lights being turned on suddenly and/or loud noises in the foaling barn. The dilemma for the owner at that point is to decide whether there is a dystocia or whether the mare temporarily stopped the birthing process.

The message, however, is clear. If in doubt, call your veterinarian.

Eye Injury

A veterinarian should be called immediately, says Stockton, if an injury or any problem develops with the equine eye. This is an area of treatment where only a trained person should be involved. The administration of proper medication is critical. What works well for one eye affliction might cause serious harm if used for a different problem, so just using the "eye ointment" in the medicine cabinet can be dangerous to your horse's sight. Immediate treatment also is a must to prevent damage that might impair the horse's sight.

The take home message from the above veterinarians is this, "Paying now" in the form of a farm call by a veterinarian often might negate the need for "paying later" during a long and costly recuperation.